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General NPI Number Information
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NPI Number | 1205819992
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Entity Type | Individual
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Provider Name | PRASADA R. KANDULA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 29000 CENTER RIDGE RD
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City | WESTLAKE
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State | OH
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Zip | 44145-5293
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Country | US
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Telephone | 440-414-6046
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Fax |
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Provider Business Mailing Address
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Address Line | 5620 SOUTHWYCK BLVD
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City | TOLEDO
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State | OH
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Zip | 43614-1501
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Country | US
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Telephone | 800-288-8325
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Fax | 419-866-5453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35061558D
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License Number State | OH
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